Morocco Complete Paper

FUNCTIONAL INTERVENTION TRAINING AND THERAPY 1
The FITT: Functional Intervention Training and Therapy:
An Occupational Therapy-Based Community Program for the MAIR Clinic
Lexi Sybrowsky
University of Utah
The FITT: Functional Intervention Training and Therapy:
An Occupational Therapy-Based Community Program for the MAIR Clinic
The purpose of this assignment is to incorporate the skills and knowledge of an
occupational therapist into a program of an underserved and rural population in Marrakech,
Morocco. A needs assessment was completed to determine the needs and gaps in the current
system. The needs assessment involved one-on-one interviews, group interviews with therapists
and patients, support groups with parents and observations of patients and therapists in the
Moulay Ali Institute for Rehabilitation (MAIR) clinic. After observation and further analysis of
the needs of the clinic and the patients, a need was identified and special importance was placed
on incorporating occupation-based and functional activities into the everyday therapy that is
currently happening at the clinic. Through the observations and direct-patient care at the site and
a literature review of pertinent topics and interventions, an occupational therapy program was
developed and proposed to assist with the current needs and gaps at the MAIR clinic.
Description of Setting
Morocco is a large, culturally rich country located in Northwest Africa. Morocco is home
to many prospering cities including the famous Casablanca, the capitol city of Rabat and the city
of Marrakech, neatly nestled between the Atlas mountains and the dessert terrain. Within the city
of Marrakech amongst the bustling medinas and suks lies the MAIR clinic. The mission of the
MAIR clinic is:
To trigger a neuroplastic change is the foundation of our therapy. To accomplish maximal
recovery is our most important goal (MAIR, 2018).

History
Though the MAIR clinic was founded in 2015, its true history began in 1999. Moulay Ali
Sbai, for whom the clinic is named after, is the brother of Mohammed (Mo) Sbai, the founder of
the clinic. Mo’s brother Moulay suffered a severe traumatic brain injury while driving in
Morocco and was left in a vegetative state for several months after. Moulay desperately needed
extensive neurological rehabilitation which was not readily available in Morocco. After two
years of extensive battling with health insurance and a lack of quality health care and therapy
available to him, Moulay was finally transferred to the United States to receive therapy in New
Jersey at the Kessler Institute for Rehabilitation. It was here that Moulay began to have an
incredible recovery and miraculous outcomes. Five years later, Moulay had improved his
cognition and memory and recovered all of his speech as well as the majority of his range of
motion and mobility on his affected side. He had a bright future ahead and was looking forward
to rebuilding his life. Moulay was required to return to Morocco to obtain a new visa and when
he tried to return to the United States, he was denied a new visa. Being stuck in Morocco meant
that Moulay was not able to receive the quality care and therapy he had been getting, and he
quickly regressed. Unfortunately, Moulay passed away in May 2007 due to a massive abdominal
infection. Ever since then, Mo has worked tirelessly to honor Moulay Ali and do everything he
could to help people like him get access to better rehabilitation and therapy in Morocco. He
started the Zahra Charity, a non-profit organization used to establish the first neuro-rehabilitation
facility in Morocco, the Moulay Ali Institute for Rehabilitation. The clinic has only been
operational for three years, but it strives to help as many adults and children as possible in
Marrakech using evidence-based therapy and standardized American approaches (M. Sbai,
personal communication, September 26, 2018).

Target Population
The MAIR clinic specializes in children and adults with neurological based diagnoses
including cerebral palsy, traumatic brain injury, spinal cord injury, multiple sclerosis and spine
and chronic pain. With a caseload of 18-25 patients a day, approximately 60-65% of the patients
that are seen on a daily basis are pediatric patients and approximately 65% of these children
having cerebral palsy. Some patients being seen at the clinic travel between 30-60 minutes using
public transportation, personal cars or motorbikes to get to their therapy appointments. There are
some patients that live in the countryside that travel for several hours to come to the clinic. While
most patients are local to Marrakech or its surrounding areas, some patients travel from the
countryside or other large cities outside of Marrakech to visit the clinic. Most of the patients are
referred to the clinic by word of mouth, though the local medical community is beginning to take
note of the work being done at the clinic and is beginning to refer more patients. Neuro-
rehabilitation is the primary treatment intervention performed at MAIR, with an emphasis on
mobility, standing and balance. Many of the patients being seen at the clinic have been receiving
treatment for two or more years, with no length of stay specified by the therapists. The motto
seems to be that if the patients are willing to work and have needs that can be addressed, they can
continue coming to therapy (M. Sbai, personal communication, September 9, 2018).
External and Internal Influences on the Healthcare System and the MAIR Clinic
Policy. The development of the Moroccan healthcare system has been heavily influenced
by the French healthcare system. The French approach to healthcare and rehabilitation is very
different from the United States. The French and the Moroccans have a bottom up approach
when viewing disability and rehabilitation as opposed to a top down approach that is taken in the
United States. This system focuses greatly on disability maintenance rather than focusing on the
patient’s rehabilitation or remediation potential. Even more concerning, this maintenance
mindset is not focused on the patient but more so focused on making adaptive changes to ease
caregiver burden (M. Sbai, personal communication, October 8, 2018).
Other policy issues related to Morocco’s healthcare system reflect the lack of access
many people have to quality healthcare services. Though the Moroccan government spends five
billion dollars on healthcare each year, there is still a lack of access for many people (Alami,
2013). Individuals and families living in rural areas typically do not have medical access nearby
and sometimes have to travel long distances if they require medical attention. Additionally, there
are not enough doctors or equipment available to perform all of the necessary medical
procedures that people may need. Due to a lack of supplies, there is a lot of guessing and
assuming happening when it comes to diagnosing patients due to the lack of supplies and
equipment needed to properly diagnosis. This leads to many unspecific or incomplete diagnoses,
which can then make treatment very difficult. There are also reports of corruption within the
public and private healthcare systems and within the community hospitals. Bribery of hospital
staff is often seen to help people avoid long waiting times or to receive medication they have not
been prescribed. Approximately 30% of people trying to access the healthcare system have
resorted to bribery in order to receive the health care and services they need (Alami, 2013).
Furthermore, there is also shortage of trained medical personnel in Morocco including doctors,
nurses and therapists (Semlali, 2010). The professionals that do end up receiving training often
end up working at state healthcare facilities, which leads to a continuation of the corruption
within the system.
Though the external policy factors have an impact on the MAIR clinic, within the clinic
itself, however, policy is much different. Due to the lack of insurance among many people in
Morocco, the therapists at the MAIR clinic are not limited to only seeing patients that have
insurance. Many of the patients being seen at the clinic do not have insurance and because of
this, there are no barriers to the frequency or duration that patients can be seen. The therapists
can dictate how many sessions patients can be seen and can work on whatever goals they feel are
appropriate (I. Bentahar, personal communication, October 7, 2018). Additionally, the
camaraderie and sense of teamwork that has been built among the therapists is something that is
truly incredible to witness. They are constantly collaborating and working as one complete unit
in order to ensure this clinic is successful and sustainable.
Geography. The country of Morocco is located on the northwest side of the African
continent and contains a variety of landscapes and terrains including mountains, valleys, coasts,
deserts and plateaus. The main geographical features in this country are the Atlas mountains that
lie in the central part of the country and the Sahara desert located in the southeastern region of
the country. The Mediterranean climate of Morocco consists of mild wet winters and hot dry
summers (World Atlas, 2017). Historically, Morocco has also been susceptible to natural
disasters including earthquakes, droughts, windstorms, flashfloods and landslides. Other
environmental concerns and issues facing Morocco include land degradation and water pollution
because of waste being dumped into the main water sources (The World Factbook: Morocco,
2018). The geography of Morocco, though beautiful and expansive, can create a barrier for those
that try to access the MAIR clinic in Marrakech. Because MAIR is the only neuro-rehabilitation
clinic currently in Morocco, patients may have to travel great distances to receive the services
and therapy they need (M. Sbai, personal communication, September 10, 2018).
Additionally, Morocco is currently undergoing a shift from rural living to urbanization. In
the past, only 30% of the total population was living in cities, but now more than 51% of the
population has shifted from living in the countryside to living in the cities. This major shift in
living has also impacted the geographical landscape of the country (Semlali, 2010). This
urbanization has also allowed for more people to have access to the healthcare facilities located
in the large cities, such as the MAIR clinic in Marrakech. Though having the clinic located in
Marrakech allows for more people to access it’s services, transportation within the city can be
difficult and dangerous to navigate due to the chaotic and somewhat disorganized traffic system.
Despite this, there are multiple forms of public transportation including city buses, taxis and
trains that can be used if individuals and families do not have access to their own personal
vehicles.
Sociocultural. There are several social and cultural factors that are currently affecting the
Moroccan people. Morocco currently has a 19% unemployment rate and 15% of the population
is living below the poverty line. Because of longstanding traditional gender roles that dominate
this country, women are less likely to hold jobs in the working sector and are often the primary
caregivers within the home (Semlali, 2010). Other cultural factors that are predominant in this
country include a low literacy rate, particularly in adults. The adult literacy rate is approximately
67% while the youth rate is slightly higher at 81.4%. The average adult literacy rate for Northern
African is approximately 83%, so Morocco’s rates are considered below average. These low
literacy rates can impact a multitude of things, including a person’s ability to understand and
navigate within the healthcare system. Though the literacy rate for Morocco are below average
when compared to African literacy rates, the literacy and employment rates for women continue
to steadily improve each year (Semlali, 2010). Additionally, the perception of children and adults
with disabilities remains negative in Morocco. Children with disabilities are allowed to attend
school but are often ignored by the teacher and students and excluded from many activities (I.
Benhahar, personal communication, October 9, 2018).
Within the MAIR clinic’s culture, however, there is an overwhelming sense of
community and camaraderie for everyone that visits. The therapists, patients and families can
often be seen working together and collaborating on treatments and home programs. This
community that has been built and nurtured by the MAIR clinic gives patients and families a
sense of belonging and strength. The parent support group run by the therapists is just one
example of how the mothers can come together and seek advice from one another. Within this
group, the women feel safe to discuss their daily struggles and challenges of raising a child with
disabilities. This sense of inclusion and kinship is something that is dominant not only within the
MAIR community but also within the overall culture as a whole.
Economic. The Moroccan community is known for having a large unequal distribution of
wealth between the rich and the poor. In the larger cities like Casablanca and Rabat where
industry and employment are consistently growing, a middle class is beginning to emerge, but
the majority of the country remains trapped in a significant economic disparity (Batnitzky,
2008). The high rates of poverty and great disparity between the rich and the poor make it
difficult for everyone to have access to healthcare or therapy. There are many people that have
disabilities who are unable to access the services they need in order to live healthier and more
productive lives. Due to the structure of the Moroccan healthcare system, many of these people
are paying for medical or rehabilitation services out of pocket, making it difficult for individuals
with lower socioeconomic status to cover the cost of the services they need (The World
Factbook: Morocco, 2018).

Despite its rocky economic history, Morocco is currently working towards building an
open, market-oriented economy. The main economic foundation of Morocco is supported by
agricultural farming (including wheat, fruits and vegetables, livestock and wine), tourism,
aerospace, phosphate mining, and textile production and exportation (The World Factbook:
Morocco, 2018). As is traditional in this culture, men are the primary economic providers in a
family while the women stay home and care for the children. In recent years, however, women
have begun to have a greater role outside the home, making up approximately 28% of the labor
force and being seen in virtually all professions (Laskaridis, 2011).
Within the MAIR clinic itself, the economic and financial regulation has been somewhat
irregular. While the clinic is able to see patients regardless of their financial situation, many
patients are not paying for the services they are receiving, making it difficult for the clinic to be
self-sustaining. Additionally, many of the patients that are able to pay are currently on the
waiting list and have not been integrated into the clinic system yet. Until these patients are
removed from the waitlist, it may be difficult for the clinic to have a consistent revenue stream
(M. Sbai, personal communication, October 6, 2018).
Political. Morocco is considered a constitutional monarchy and is one of the oldest
monarchies in the world. The King of Morocco, Mohammed VI of Morocco, has been the leader
since 1999 and is also the Chief of State and the Supreme Leader of the Army (The World
Factbook: Morocco, 2018). The current king is considered to be very progressive and is making
great strides to make healthcare more accessible to everyone in the country. Both national and
private health insurance is available but is considered expensive and may limit where a person
can receive care (Morocco Health Insurance, 2018).

The greatest political impact on the MAIR clinic itself is the overall corruption within the
healthcare system in Morocco. MAIR is striving to stray away from the corrupt practices that are
dominant in the national healthcare system and is instead following a typical American
rehabilitation model. The therapists at the clinic have received equal training and education
within the private sector and are being paid a competitive salary that is equivalent to what they
would make working in public healthcare system (M. Sbai, personal communication, October 4,
2018).
Demographic. The country of Morocco is home to more than 33 million people and
covers over 274,000 square miles of land situated in the northwestern part of Africa. Morocco is
very ethnically uniform, with approximately 99% of people being Arab-Berber. The country’s
official language is Arabic, but many other languages are spoken there including a variety of
Berber languages as well as French and English. Islam is the dominant religion in Morocco,
again with approximately 99% of the population being Muslim (The World Factbook: Morocco,
2018). Morocco is considered a young country, with approximately 27% of its population under
the age of 15, with an average age of only 29 years old (Morocco population, 2018). The country
is also undergoing a demographic shift, with its population growing but at a declining rate. This
is due to a variety of factors including better healthcare and nutrition as well as women living
longer but having fewer children (The World Factbook: Morocco, 2018).
Services Provided
Staff. The staff at the MAIR clinic are referred to as neuro-therapists that have
experience and training with the populations that frequently visit the clinic. There are currently
three full-time neuro-therapists on staff at the clinic. The therapists have 3 years of physical
therapy education post high school, which is equivalent to that of a physical therapy assistant in
the United States. This education is considered fairly basic but covers general anatomy and
physiology topics. Currently, there are no occupational therapists working at the clinic, but there
has been an occupational therapy presence within the clinic with the presence of a level II
student and other student interns that have rotated through for a few months at a time over the
past three years. The University of Utah Life Skills Clinic has also had an influence on the
therapy that goes on here. The director of the Life Skills Clinic, Heidi Wooley and level II
students visited the clinic two years ago and provided additional trainings and in-services for the
therapists at the clinic. Currently, the programs being implemented at the MAIR clinic include
feeding therapy, gait training, cognitive therapy, range of motion (ROM)/stretching and balance
and vision therapy (M. Sbai, personal communication, September 9, 2018). The therapists stated
that they love working in the medical field and are motivated to work with these children and
families on a daily basis (I. Bentahar, C. Elghazi, S. Berrada, personal communication, October
12, 2018).
Related services. Due to the limited access to healthcare services in Morocco, there are
minimal related services that these patients receive. Patients must frequently visit the doctors and
neurologists at the community hospitals in order to receive prescriptions for therapy. Due to this
need for new prescriptions, the therapists attempt to be in communication with the doctors about
the patients they are seeing. The therapists admit, however, that it is very difficult to collaborate
with these doctors because patients typically see a new doctor each time they visit. This makes
tracking progress with patients extremely difficult and may be a potential reason that patients are
never really discharged from the MAIR clinic.
The therapists at the MAIR clinic work in a multi-disciplinary role, covering the job
duties of nutritionists, occupational therapists and speech therapists all within their primary
physical therapy role. These therapists are constantly evaluating and looking at multiple factors
with each patient and doing their best to figure out how to provide the most comprehensive care.
Though they carry a heavy workload, the therapist have recently gained access to a social worker
within the local community that assists with determining patient care costs for therapy. The
family income, transportation and other factors are taken into consideration by this social worker
to determine an appropriate payment for therapy. This additional consultation has had a
tremendous impact on the financial progress of the clinic and has helped filter out dishonest
patients (M. Sbai, personal communication, October 9, 2018).
Funding sources. Currently, the MAIR clinic is being funded by the Zahra Charity, the
non-profit started by Mo Sbai in 2009. The Zahra charity uses grants and private foundations and
donations to fund all MAIR operations on a day-to-day basis. The clinic has also partnered with
the Salt Lake Rotary Club, which provides all the funding necessary for medical training for the
clinic’s staff. Though many of the daily expenses are being paid for using the above listed grants
and other funding resources, recently the clinic has begun to charge patients a small fee for their
services. Full sessions rates are typically between $2.50-$20 per session. Only a small percentage
of the patients being seen at the clinic have insurance that is willing to reimburse them for their
therapy. In the clinic’s infancy, clients were not required to pay for the services they were
receiving, but recently there has been a change. In order to help the clinic become more self-
sustaining in the long term, clients were asked to put some money towards their therapy.
Additionally, Sbai felt that having patients contribute financially to their therapy helped create
more buy-in throughout the process and help clients became more motivated to participate in
their therapy (M. Sbai, personal communication, September 9, 2018).

Future plans. Mo Sbai and the clinic staff have incredible dreams and goals for the
MAIR clinic. As mentioned earlier, Sbai would like the clinic to be self-sustaining and be able to
generate its own revenue. Sbai dreams of one day building a one-of-a-kind neuro-rehabilitation
campus in Marrakech complete with a 50,000 square foot rehabilitation center, education
building and apartment suites for patients and volunteers to stay in. A project this extensive
would range anywhere from $5-7.5 million dollars to complete, and Sbai currently has $500,000
saved up. With this dream in the forefront of his mind, Sbai would like to accomplish this goal
and grow the clinic in the next 5-10 years (M. Sbai, personal communication, October 12, 2018).
Programming Strengths and Areas for Growth
Director and Therapy Staff Perspective
Director of clinic. A group interview was conducted with Dr. Mohammed Sbai, the
founder of The Zahra Charity and the MAIR clinic to get his perspective on the overall strengths
and weaknesses of the clinic. Sbai stated that one of the greatest strengths of the clinic is the
staff’s dedication and compassion towards all their clients. In a country where corruption and
deception are prevalent in the healthcare system, Sbai felt that the staff and the clinic had an
excellent reputation within the community and would continue to grow and have greater success.
He also felt that the staff’s skillset and education were some of the best in the country, but agreed
that further development of skills and trainings was an area that could constantly be improved.
Other areas for growth identified by Sbai include a need for better scheduling and administrative
organization for the clinic. Currently, there is no official system for scheduling patients,
organizing therapist’s documentation or accessing patient medical records. This disorganization
makes it difficult to regulate the number of patients coming to the clinic on a daily basis and
creates some confusion amongst the therapists about patient’s progress in therapy. Additionally,
the clinic continues to battle the problems that come with working in a small space. The current
clinic space is approximately 2,700 square feet, making it difficult for the three full-time
therapists to have enough space to work with clients. As the demand for neuro-rehabilitation
services grows and the clinic continues to expand, these issues will create a barrier unless they
are addressed (M. Sbai, personal communication, September 10, 2018).
Therapists. To gain a greater understanding of the therapist’s perspective, a group
interview was initially conducted with the three full time neuro-therapists currently working at
the clinic on September 17, 2018 via video conferencing as well as several one-on-one
interviews once in Morocco. The lead therapist and manager Imane Bentahar as well as Shaymae
Elghazi and Sophia Berrada are the three full-time therapists currently working at the clinic. In
their interviews, they described their daily routine at the clinic, the types of patients they see,
their typical caseload and their educational background. Additionally, the therapists explained
some of the clinic’s current strengths and what is working well which included their ability to
implement locomotor training (standing, walking, and balance activities), stretching and
strengthening programs and other locomotion therapy. Due to the educational background of the
therapists, the primary focus of their treatments at the clinic are typically centered around
walking and mobility, though they have taken on a multi-disciplinary approach with each of their
clients and work on a variety of tasks and goals. Other strengths of this staff include their
willingness to learn about topics outside their scope of practice in order to provide their patients
with more comprehensive care. Some common weaknesses that were addressed by the therapists
included their limited education and resources to learn about diagnoses and treatments they are
seeing more frequently at the clinic. The therapists wished that they could provide greater
therapy focused on autism, cognition and attention, and post-stroke treatments. Additionally, the
small workspace was another challenge frequently brought up by the therapists (I. Bentahar, C.
Elghazi, S. Berrada, personal communication, October 10, 2018).
Parent and client perspective. In order to improve our understanding, one-on-one
interviews were conducted and participation in a parent support group was completed to gain a
more realistic perspective of the parent’s supports and challenges within this community. Due to
the language and cultural barriers, no formal assessments were used to gather information and
data from the parents and families. A common theme that emerged in one-on-one interviews was
that of praise and gratitude for the work that was being done at the clinic. Many of these mothers
felt that their children were receiving amazing care and attention from the therapists and
personally felt that their greatest support was the MAIR community. Throughout the parent
support group, many of the mothers shared stories and advice with one another and were
constantly thanking the therapists for the dedication and love they had for each of their children.
In one-on-one interviews conducted during therapy sessions, the mothers heavily emphasized the
desire they had for their children to walk again and to be able to be more independent with their
activities of daily living (ADLs) and other occupations. The children also had similar goals,
stating they wished that they could participate more during playtime, at school and at home.
With these goals in mind, the therapists are able to train the mothers and integrate them into the
therapy process, making them an essential and invaluable member of the team (Parent support
group, personal communication, October 12, 2018).
Student perspective. After completing observations, interviews and trainings with
patients, parents and staff at the MAIR clinic for two weeks, there were many strengths and areas
of growth identified. The clinic in Marrakech is truly a one-of-a-kind clinic that is able to
provide rehabilitation services to many people that need it. Some of the greatest strengths of the
clinic and of the overall community is the sense of friendship and kindness that has been built.
The therapists truly care about every patient that walks in the door and will go out of their way to
help in any way they can. Additionally, their willingness to listen, learn and integrate what they
are being taught is something that is unmatched or like anything I’ve ever seen. They were
constantly asking questions and were always open to the feedback we had to give. Furthermore,
the therapists at MAIR are very persistent and adamant about involving families in the therapy
process. It is very common in the clinic to see the mother’s performing range of motion,
stretching, strengthening or walking with their children, performing in a co-treating fashion
alongside the therapists. This team dynamic is essential to the therapy process and something
that the clinic takes seriously and does very well.
Completing daily observations and working alongside the therapists also gave me the
opportunity to identify areas of growth for the MAIR clinic. One of the greatest needs I was able
to identify is the clinic’s evaluation and discharge process. Currently, the evaluation consists of a
very basic and brief interview along with some additional testing, if necessary. Many of the
questions asked are centered around the patient’s medical history and goals for therapy, but they
do not go into great detail about the patient’s daily routine, supports and barriers, family
dynamics or environment like a typical occupational therapy evaluation would. Additionally,
there is not current discharge planning happening at the clinic. The clinic is consistently crowded
and busy and the therapists admit that some kind of discharge planning would be beneficial in
order to open up their caseloads to other clients. Other areas for growth that were identified were
the need for greater education and trainings for the therapists. Though they are considering
themselves “neuro-therapists,” they have only received three hours of neuroanatomy training in
their three years of schooling. Additional training and education centered on neuroanatomy and
neurological diagnoses and treatment would be extremely beneficial for these therapists if they
want to increase their standing in the rehabilitation field. Furthermore, another need for this
clinic is their focus on occupation and functional-based therapy. Though this clinic is more
physical-therapy focused, it would be valuable to introduce and integrate occupational therapy
into this clinic, as there has been a need and desire for these types of interventions to be
established by the families, therapists and Sbai.

Evidence-Based Practice Literature Review
An evidenced-based literature review was completed to gain a better understanding of the
occupational needs of children receiving rehabilitation services in Marrakech, Morocco as well
as to establish evidence for the integration of occupational therapy services within the Moulay
Ali Institute for Rehabilitation (MAIR) clinic. The American Journal of Occupational Therapy as
well as databases including Google Scholar, PubMed and the Spencer S. Eccles Health Sciences
Library through the University of Utah were searched for pertinent articles and case studies.
Search terms included a combination of the following: occupational therapy (OT), occupation,
occupation-based interventions, functional-based interventions, international healthcare,
activities of daily living (ADLs), self-care, rehabilitation/treatment/intervention, programs,
children, pediatric, and cerebral palsy (CP). Effective treatments focused on occupation or
functional-based interventions were the primary focus of this search, and articles were kept or
discarded based on the overall relevance of the research to this proposed program. 11 articles and
one textbook were referenced and kept as part of this literature review.
Commonly seen patient characteristics and diagnoses
In order to understand the needs of the population at the MAIR clinic in Marrakech,
Morocco, literature was reviewed to gain a greater evidence-based perspective on commonly
seen diagnoses and patient characteristics for this population. The most common diagnosis
currently being treated at the MAIR clinic is cerebral palsy (CP). Approximately 65% of the
pediatric population at the MAIR clinic has been diagnosed with CP or has CP-like symptoms or
characteristics but remains undiagnosed (M. Sbai, personal communication, September 9, 2018).
Other diagnoses commonly seen by the therapists working at the clinic include traumatic brain
injury (TBI), spinal cord injury (SCI), stroke and autism. While there are many diagnoses and
other populations being served at the MAIR clinic, the focus of this literature review was on the
pediatric patients and the diagnosis of CP. CP can have tremendous impacts on a child’s
development and ability to participate in everyday occupations, so this diagnosis and population
is the focus of this occupation-based program proposal and literature review.
Typical characteristics of the pediatric population in this setting include increased rates of
poverty, low familial socioeconomic status (SES), and low literacy rates. According to
Abdesslam (2012), Moroccan healthcare personnel conduct regular surveys on population and
family health. The National Survey on Population and Family Health (NSPFH 2011) found that
nearly half of the total population was illiterate, which in turn would have a tremendous impact
on a family’s ability to understand and participate in their child’s healthcare. The rate of
illiteracy reaches approximately 48% for women and 26% for men. With women being the
primary caregivers in the household, it is important that they are able to understand and advocate
for the therapy and rehabilitation services their children need. If they are unable to do so, there
can be tremendous impacts on the children and their overall health.
Other secondary factors that also impact this pediatric population include the high
unemployment rate in Morocco, particularly among women. The unemployment rate is over 80%
for women living in cities and can be as high as 94% in rural areas and neighborhoods
(Abdesslam, 2012). The high unemployment rates among men and women in Morocco has a
significant impact on a family’s ability to afford and access quality healthcare. Additionally,
many of the children that are patients at the MAIR clinic are living in poverty and have limited
access to proper healthcare services. While this NSPFH report shows that Morocco has begun to
take greater strides to combat these issues in recent years, there are still significant gaps that need
to be addressed in order to improve health for all.

Viewing occupation from a worldwide lens
In order to gain a better understanding of the role of therapy and rehabilitation in
Morocco, literature was reviewed to identify characteristics and potential gaps in the current
services provided focused on these areas. According to Martin, Martos, Millares and Björklund
(2015), occupation and occupational therapy are not cross-culturally universal concepts that are
easy to understand. However, as occupational therapists, we have a unique perspective that
allows us to analyze and integrate a broader cultural perspective into our practice in order to
better understand how different occupational experiences impact a person’s everyday life. In
developing this understanding, we first need to recognize how occupation is viewed on a broader
scale in other countries. Martin et al. (2015) conducted a study to analyze worldviews regarding
human occupation and the link between occupation, health and well-being. Their research was
conducted in five countries, including Morocco, and found that while the term occupation varies,
the essence and meaning of the word remained fairly consistent. The participants in this study
emphasized how important it is to participate in “occupations that were related to belonging and
being connected to their families and communities in order to maintain their overall health and
well-being” (Martin et al., 2015, p. 88). When planning and implementing an occupation-based
program at the MAIR clinic, it is important to understand how everyday occupations vary and
differ across cultures, but also how they have similar meanings and values to each individual.
Through interviews conducted with parents, families and therapists at the MAIR clinic,
participation in daily occupations was frequently identified as an important goal for each child
and should be emphasized during their rehabilitation process (I. Bentahar, personal
communication, October 7, 2018).

Therapy and rehabilitation in Morocco
Due to the current healthcare system in Morocco, therapy and rehabilitation services are
scarce. The MAIR clinic currently has three physical therapists working full-time, but does not
currently employ an occupational therapist. Occupational therapy has not yet been readily
introduced to the Moroccan healthcare system, so there is little evidence available to show how
the profession can be beneficial in this country. Despite the lack of an OT presence in Morocco
and at the MAIR clinic, it is still important to understand the role that OT can have in this setting
and within an interdisciplinary team. Majnemer et al. (2013) conducted a study that emphasized
the importance of rehabilitation services for children and adolescents with CP. The authors found
that the children that received more than one type of rehabilitation service (including
occupational therapy, physical therapy (PT), or speech therapy) had greater ability and
independence when participating in daily activities. Results also showed that a shift from a strict
one-discipline approach for therapy to a multi-disciplinary approach enables children with CP to
receive more comprehensive and specialized care. Similar results were reported in Palisano et al.
(2012) supporting the importance of coordination between OT and PT services for children with
CP. Though this study noted that the vast variations within a country’s healthcare system has an
impact on the amount of rehabilitation and therapy services a child receives, the flexibility of the
Moroccan healthcare system could allow the children being seen at the MAIR clinic to receive
both OT and PT services, if they were available. Having this dual-centered treatment would
allow the MAIR clinic to expand their services and provide greater comprehensive care to each
patient.
Role of occupational therapy in cerebral palsy rehabilitation
Due to the significant emphasis placed on family-centered care both culturally and within
the MAIR clinic, understanding family values and priorities is key when providing any type of
rehabilitation or therapy. Currently, the neuro-therapists at the MAIR clinic have a substantial
focus on locomotion and gait training with their patients with cerebral palsy, but parents and
families have also mentioned how important it is that their children are able to participate in
other activities of daily living and occupations. Chiarello et al. (2010) completed a study that
analyzed and categorized parent and family priorities for participation of children with cerebral
palsy. Results of this study found that though parent priorities varied depending on the age and
gross motor function of their child, the most frequent priority reported by parents for all children
was participation in daily activities. More specifically, parents reported that they wanted their
children to gain greater efficacy and independence in self-care activities like dressing and
feeding. Similar results were found in other studies focused on a child’s main occupation of play.
Play and leisure are considered important occupations for children to participate and have access
to in order to develop and grow. Majnemer et al. (2008) conducted a study that described the
levels of participation and enjoyment in leisure activities for children with CP. Results of this
study found that children with CP had disruptions in their participation of these activities and
that therapy or rehabilitation services could be used to address deficits or challenges with these
activities. The authors also noted that children that continued to receive rehab and therapy
services had a greater chance of participating and improving their skills related to leisure
activities. It is important to remember that play and/or leisure is considered to be a vital
occupation for a growing and developing child to participate in and this is an area that OT can
specifically aide in. Occupational therapists are experts in evaluating, assessing and providing
interventions in these areas and the need for an occupational therapy presence at the MAIR clinic
continues to be solidified by the evidence-based research presented here.
Additional research is available that emphasizes the importance of occupation-based
therapy for children with cerebral palsy. Vargus-Adams and Martin (2009) evaluated which
treatment areas were most important for children and youth with CP. Using various
questionnaires and interviews of children, parents, and medical professionals with CP expertise
to determine which treatment domains were of the most importance. The domains identified in
this study would be used as a set of core outcome measures for children with CP. Overall, eight
domains emerged as important areas to address in therapy, including the areas of self-care and
independent living skills. Though these domains were not ranked in this study due to the fact that
they “are all important interlocking issues that all matter fairly equally” (Vargus-Adams and
Martin, 2009, p. 2,091), the fact that these occupation-based areas were present on the list
indicates how important they are to address as a core outcome in therapy for children with
cerebral palsy. Adding these specific types of interventions and outcomes for patients being seen
at the clinic would create a more comprehensive plan of care for each patient while still allowing
the therapists at the clinic to achieve other physical-therapy specific outcomes.
Effects of Occupation and functional-based therapy in children
Ketelaar, Vermeer, Hart, Beek, and Helders (2001) studied the effects of functional
therapy for children with CP. In this study, functional therapy emphasized the learning of skills
that are meaningful to the child and are best learned by repetitive practice of tasks in functional
situations. Results of the study revealed that the children in the group that received functional
therapy had higher scores on the Pediatric Evaluation of Disability Inventory (PEDI) than the
children in the typical therapy group, indicating they had better performance and more
independence during self-care activities than the group that received typical physical therapy
(PT) interventions. The findings show that using functional therapy programs had positive
effects on the child’s ability to perform daily self-care tasks. Similar results were reported in a
study done by Law et al. (1998) evaluating the effects of a family-centered functional approach
to therapy for children with CP. Results of this study indicate that having a family-centered
functional approach to therapy allowed for greater accomplishment of goals and participation in
desired tasks. At the MAIR clinic, the family is extremely involved in the therapy process so
evaluating the effects of a family-centered approach was essential in developing an occupation-
based program.
Furthermore, Law et al. (1998) noted the importance of having an interdisciplinary team
as part of this study (i.e. an OT/PT team) allowed the therapists to more easily collaborate to
identify appropriate intervention strategies for each child. This study supports the idea of having
an OT/PT team working collaboratively at the MAIR clinic to treat their pediatric cerebral palsy
population. Together, these studies support the idea that an occupational therapy presence at the
MAIR clinic would be a viable option in order to implement more functional and evidence-based
therapy interventions. Though the Ketelaar et al. (2001) study focused on physical therapists
carrying out the functional therapy, it is important to note that an occupational therapist
implementing these interventions would be of an additional benefit because of their knowledge
and expertise on the occupations being performed as well as their ability to perform activity
analysis and identify contextual and environmental supports and barriers for each patient.
Approaching therapy from an occupation-based perspective not only allows a child to
improve their performance in everyday occupations, but it also correlates with improved motor
performance. As previously mentioned, many of the goals identified by parents and families at
the MAIR clinic are focused on increasing the child’s gross-motor functions, which in turn
increases their ability to participate in desired occupations. Ahl, Johansson, Granat and Carlberg
(2005) found a significant correlation between functional therapy and improved gross motor
function in children with cerebral palsy. The children that participated in the study’s functional,
goal-directed therapy group simultaneously increased their gross motor performance and their
ability to participate in self-care tasks. The findings from this study support the integration of a
functional and occupation-based program into the MAIR clinic as it shows evidence of the
program’s ability to achieve both physical therapy directed goals and parent goals centered on
increased participation in everyday occupations.
Implementation of functional and occupation-based therapy
As occupational therapists, one of the first approaches we have when focusing on
occupation-based and functional therapy for children with CP is using activity analysis to assess
activities and occupations. Case-Smith and O’Brien (2014) discuss the idea that activity analysis
is a way for therapists to identify the necessary skills required for a task as well as the
discrepancy between the task requirements and the child’s performance and capability. In
implementing activity analysis, the therapist “gains a solid understanding of the strengths,
concerns, and problems of the individual involved” and can “individualize the supports needed
for the child to accomplish the task” (Case-Smith & O’Brien, 2014, p.5). In choosing an
appropriate occupation-based task for a child with CP, it is important for the therapist to select
tasks that can be easily adapted and modified to meet the needs and abilities of the child (i.e.
providing a just right challenge). By adjusting and modifying the activity or occupation the child
is performing, the therapist is using their clinical reasoning to grade the activity appropriately. In
using this gradual grading approach, the therapist is able to maximize the child’s involvement
and success in the therapy process. Another integral part of providing occupation-based
interventions for children with CP is to select and adapt activities that are meaningful for the
child. According to the study completed by Chiarello et al. (2010) that was discussed earlier, the
authors noted that there was greater participation in therapeutic interventions when the child was
able to choose the activity. The child’s preference and intrinsic motivation for the activity played
an important role in building the skills, confidence and competence necessary for them to
participate in the desired activities or occupations during therapy. The type of therapy being
provided, as well as the way it is delivered and modified, is something that requires specialized
focus and training in order to achieve the greatest effect for each patient. As occupational
therapists receive extensive training and education in these areas and approaches, it would be
important to have an occupational therapist implement these types of interventions at the MAIR
clinic alongside the current neuro-therapists working there.
Summary
In order to fully understand the needs of the clients being seen at the MAIR clinic, it is
important to reflect back on their mission. The foundation of rehabilitation at MAIR is “to trigger
a neuroplastic change” and achieving maximal recovery is their most important goal (MAIR,
2018). The clinic strives to provide the best therapy and rehabilitation services to its patients by
providing one-of-a-kind rehabilitation in Morocco. In studying the available literature,
occupation and functional-based interventions have strong evidence to support their effectiveness
when incorporated to therapy for children with cerebral palsy. CP is one of the most common
physical disabilities that affects children worldwide and greatly impacts a child’s ability to
participate in daily activities (Engel-Yeger, Jarus, Anaby, & Law, 2009). While there are many
rehabilitation services currently offered at the clinic to support children with CP, the lack of
occupational therapy and occupation-based interventions available is apparent. In order to
execute these interventions and implement this program, the MAIR clinic would greatly benefit
from having an occupational-therapist on staff or available in a consultative role. After reviewing
patient and family interviews at the clinic, it is apparent that these types of interventions are
desired and are the focus of many goals established for each patient. This program would
improve a child’s ability to participate and be more independent in their everyday occupations
and would increase their competence and confidence to engage in meaningful and desired
occupations throughout their entire life. A combination of this literature review and the results of
the needs assessment shows the intense need for an occupation and functional-based program at
the MAIR clinic implemented by an occupational therapist. This program would support the
work currently being done at the clinic while also providing an opportunity for the clinic to grow
and expand their services. An occupation and functional-based program fills a need that was
identified by the director, therapists and families at the clinic and would allow the MAIR clinic
to provide more comprehensive care to patients with cerebral palsy, enabling each patient to live
a more successful and occupation-rich life.

Program Proposal
Functional Intervention Training and Therapy Program (FITT): An Occupation-based
Intervention Program
Program Overview
A program that focuses on educating the therapists about occupation-based interventions
will benefit the MAIR clinic as they aim to grow their clinic and expand the rehabilitation
services they are able to provide to their patients with cerebral palsy. This program will address
the gap in services identified by the needs analysis as well as addressing the barriers found in the
literature review. This program will support the MAIR clinic’s mission statement while adding in
a client-centered approach to patient care.
The program will provide the therapists working at the MAIR clinic with the knowledge
and skills necessary to implement occupation-based interventions with their patients with
cerebral palsy. Currently, the therapists are focused on providing biomechanically-based therapy
for their clients, as many of the parent’s desires and goals are focused on mobility. Though
mobility is an important goal for children with cerebral palsy to have, it is equally important
ensure that they are able to participate in meaningful occupations on a daily basis. Implementing
the Functional Intervention Training and Therapy Program (FITT) will allow the MAIR clinic
therapists to provide more comprehensive care for their patients and will provide patients with
the opportunity to increase their skills and ability to participate in desired occupations.
Ideally, an occupational therapist would implement this type of therapy, as they are
considered experts in occupation. Unfortunately, due to financial constraints faced by the clinic
and the unavailability of a full-time occupational therapist in Morocco, this program instead
focuses on providing the therapists currently working at the MAIR clinic with a brief training
that would allow them to implement these interventions on their own. This week-long training
will focus on educating the therapists about the importance of occupational participation in a
child’s life and ways that meaningful and desired occupations can be identified for each patient.
Additionally, this training will touch on principles of activity analysis as well as ways that the
therapist can modify and adapt an occupation and the environment to match the child’s current
abilities and promote change. Finally, this training program will use hands-on opportunities to
allow the therapists to directly work with their patients alongside the occupational therapist in
order to identify and implement occupation-based interventions for their patients with cerebral
palsy.
Program Value
This program aims to help children with cerebral palsy increase their independence and
ability to participate in daily occupations through targeted occupation and function-based therapy
and rehabilitation services at the MAIR clinic. In participating in this program, these children
will increase their engagement and satisfaction in important occupations and activities in their
everyday life. Additionally, this program will decrease caregiver burden by teaching these
children to be more independent and efficient in completing daily occupations like dressing,
feeding and self-care tasks. This program will prepare these children at the MAIR clinic to make
important transitions and will allow them to actively engage in meaningful occupations
throughout their entire lifespan, while in turn decreasing caregiver burden, increasing client and
parent satisfaction and increasing client participation and independence. This principles and
ideas that this program is based on closely aligns with the MAIR clinic’s mission statement and
overall philosophy to provide comprehensive care to every patient.

Prevention
In healthcare, preventative medical approaches and measures are focused on avoiding or
preventing disease from occurring. This occupation-based intervention program addressed the
three categories of prevention in a variety of ways. As this training is provided to the therapists at
the MAIR clinic and directed specifically towards children with cerebral palsy, primary
prevention measures would not be valid as the children already have an existing diagnosis.
Secondary prevention measures can be addressed in this program by having the therapists
regularly assess the child’s occupational performance and participation in order to better identify
what occupations need to be addressed in therapy. This can be done by educating the therapists
about using the Canadian Occupational Performance Measure (COPM), which is a semi-
structured interview used to identify an individual’s current engagement and satisfaction in
everyday occupations. This interview should be administered during the evaluation process and
re-evaluated on a yearly basis (or as needed) to obtain new client-centered goals. In
implementing this practice, therapists should be able to consistently identify and work towards
occupation-centered goals for each patient with cerebral palsy.
Finally, tertiary preventative measures will be provided in the form of direct
implementation of occupation-based interventions by the therapists at the MAIR clinic. This
program will provide the necessary education and training for the therapists to be able to offer
these specific treatments to their patients with cerebral palsy. This will provide these patients
with greater comprehensive therapy that focuses on increasing their engagement in meaningful
activities and occupations, which will improve their overall quality of life.
Occupational Justice
This occupation-based training program also has a direct impact on occupational justice.
Occupational justice is the belief that all humans have the right to engage in meaningful
occupations (Scaffa & Reitz, 2014). More specifically, this program will decrease the amount of
occupational deprivation and occupational alienation experienced by the clients being seen at the
MAIR clinic. In particular, children with cerebral palsy are at greater risk for occupational
deprivation due to poor physical health and the presence of their disability. Additionally,
occupational deprivation is the result of external circumstances or limitations that prevent the
child from being able to participate in meaningful occupations. This program seeks to address
this concern by educating therapists about identifying meaningful occupations that can be
implemented into the therapy process for each patient. Furthermore, by modifying environmental
barriers and assessing client factors and performance skills, therapists will be able to better to
implement occupation-based interventions that are optimally aligned with the child’s current
abilities. In doing this, occupational deprivation can be decreased for this population.
Similarly, children with cerebral palsy receiving therapy at the MAIR clinic are also at
risk for occupational alienation. Occupational alienation is caused by a lack of satisfaction in
one’s occupations that leads to experiencing a life with less meaning (Scaffa & Reitz, 2014).
Children with cerebral palsy often have less occupational engagement due to physical and
environmental limitations, which can directly impact their satisfaction and amount of time spent
participating in meaningful occupations. The purpose of this program is to ensure that the
therapists at the MAIR clinic receive the education and training necessary to implement
occupation-based interventions with their patients with cerebral palsy, which can help decrease
occupational alienation from occurring with this population. If these children are able to maintain
the ability to participate in daily and meaningful occupations, it will increase their satisfaction
and overall quality of life.
Rationale for Occupational Therapy’s Role
For a child with cerebral palsy to actively engage and participate in desired daily
occupations, it is important to understand the child’s motor function and environment that these
occupations will be taking place in. Furthermore, it is also important to have an in-depth
knowledge and understanding of occupation and ways that daily occupations can be modified
and adapted to fit a child’s abilities. Occupational therapists are experts in evaluating, assessing
and providing interventions in these areas while simultaneously addressing a child’s functional
abilities. Additionally, occupational therapists are experts in understanding and analyzing
occupations in a way that no other health professional can, which makes them highly qualified to
implement occupation-based interventions with this population. In an ideal setting, an
occupational therapist would be providing these direct services to the children at the MAIR
clinic, but due to a lack of funding and availability of a full-time occupational therapists to
implement these services, this program will instead be focused on training the current neuro-
therapists at the MAIR clinic in the previously mentioned areas. A skilled and knowledgeable
occupational therapist will be brought in to provide program training and educate the therapists
about implementing occupation-based interventions with their patients with cerebral palsy.
Theoretical Foundation
Theoretical practice models are used to help inform professional practice and guide
therapeutic interventions. These models help an occupational therapist analyze and understand
occupation, postulate how changes will be made and predict expected outcomes when
implementing the model into their practice and interventions. Three theoretical practice models,
two organizing models and one complementary model, have been selected to support this
program and guide program outcomes towards increasing occupational engagement and
satisfaction in this population.
Person, Environment, and Occupation (PEO) is an organizing practice model that focuses
on enabling occupational performance for individuals who are not satisfied with their current
performance due to a lack of congruence between the person, the environment, and the
occupation. This model postulates that progress in the transaction between the person,
environment and occupation improves the patient’s performance in occupation. Additional
postulates of change for the PEO model focus on the individual’s environment and how it can
enable or constrain occupational performance. The PEO model’s theory and change postulates
closely align with the foundation of this program, which focuses on addressing various physical
and environmental factors in order to enable occupational performance for children with cerebral
palsy (Law et al., 1996).
An assessment frequently used alongside the PEO model is the Canadian Occupational
Performance Measure (COPM). The COPM is a semi-structured interview used to identify an
individual’s current occupational engagement and allows them to rate the importance,
performance and overall satisfaction with those occupations. Using the COPM within this
program will allow the therapists to better understand a child’s occupational routines as well as
helping to identify areas of concern and priorities within those occupations that can be addressed
in therapy (COPM, Canadian Occupational Performance Measure, 2018).
The Model of Human Occupation (MOHO) is another broad theoretical model that is
essential to include for the foundation of this program. This model focuses on optimizing an
individual’s participation in occupation while simultaneously considering how the person’s

characteristics and the external environment come together within a functional activity.
Additionally, this model focuses on an individual’s volition in order to identify meaningful
occupations to address throughout the therapy process. MOHO will be used in this program to
help guide the therapists in identifying desired and motivating occupations that can be
implemented into therapy for each child. When incorporating occupation-based interventions
into a child’s therapy, it is important to identify and utilize motivating occupations to increase
patient buy-in, which then in turn increases patient motivation and satisfaction with their
occupational participation (Kielhofner, 2009).
The Motor Skill Acquisition model is a complimentary occupational therapy model that
is focused on using functional tasks and active learning to facilitate a child acquiring new or
more efficient motor skills which improves their ability to perform specific tasks and
occupations. This model primarily focuses on individuals with motor delays and their ability to
learn more skilled motor movements. Much of the therapy being done at the MAIR clinic is
centered around a child’s motor skill development, this model allows a therapist to remain
focused on those specific performance skills while additionally incorporating more functional
tasks into therapy. Furthermore, the postulates of change within this model state that if there is a
match between the task requirements, the environment and the child’s ability, then it is more
likely that motor skill acquisition will be improved. This model encourages the child to be an
active learner throughout the process and builds in opportunities for exploration to allow trial and
error to occur. Additionally, instituting repetitive practice of the motor movements in a natural
environment will help the child retain the skills they have learned for a longer period of time
(Kaplan, 2010). Using this model as a foundation for this program will allow an occupational
therapist to train the neuro-therapists at the MAIR clinic how to incorporate functional tasks and
occupations into a child’s therapy while still focusing on the overall motor movement and skill
acquisition.
Goals and Objectives
Goal 1: Therapists at the MAIR clinic will independently increase competency in identifying
occupation-based interventions for children with cerebral palsy.
Objective 1: Therapists will independently identify one occupation-based goal for each
child with cerebral palsy to add to their plan of care within 3 months of receiving training.
Objective 2: Therapists will independently utilize occupation-based questions or
assessments (such as the COPM) during the evaluation process in order to identify client-specific
occupation-based goals within 3 months of receiving training.
Goal 2: Therapists at the MAIR clinic will independently implement occupation-based
interventions within daily therapy for children with cerebral palsy.
Objective 1: Therapists will independently utilize principles of activity analysis to adapt
activities to match client abilities within 3 months of receiving training.
Objective 2: Therapists will independently modify environmental barriers that are
impeding occupational performance for children with cerebral palsy during therapy sessions
within 3 months of receiving training.
Functional Intervention Training and Therapy Program
The Functional Intervention Training and Therapy (FITT) program is a training program
designed for neuro-therapists at the MAIR clinic that focuses on implementation of occupation-
based and functional interventions for children with cerebral palsy. Due to the unsteady nature of
the Moroccan healthcare system as well as the lack of post-graduate education provided to the
therapists, there is a strong need for occupation-based intervention program to be implemented at

the MAIR clinic. As previously mentioned, the MAIR clinic is also the only rehabilitation clinic
that provides these kinds of services in Morocco, so increasing the type of therapy they are able
to provide is vital for this population. As previously outlined in the needs analysis portion of this
proposal, the Moroccan people still view disability in a negative light. Introducing a program like
the FITT to this country will increase understanding of a child’s ability to perform and
participate in daily occupations. This will be accomplished by providing the MAIR clinic
therapists with necessary training to implement occupation-based interventions with children
with cerebral palsy.
Program structure. This week-long training program will combine education and
hands-on opportunities that focus on teaching the therapists how to identify and incorporate
occupation-based interventions into their daily practice. The five-day course will be broken up
by topic, with a new topic presented each day. The first five hours will be focused on educating
the therapists and will be structured in the form of PowerPoint presentations, discussion groups,
evidence-based reading assignments and case studies. The remaining three hours left in the day
will be set aside for hands-on opportunities to work directly with the MAIR clinic therapists and
their clients. This will allow each therapist to work one-on-one with their clients alongside the
occupational therapist at least one time per day. Prior to beginning the training, the therapists
will be asked to prioritize and schedule therapy times with their clients with cerebral palsy
during these hands-on sessions to give the therapist a chance to implement what they were taught
throughout the day and receive direct feedback from the occupational therapist.
Daily schedule and session breakdown. The first session of this program will be
focused on providing an overview and explanation of what occupation is. In order to implement
an occupation-based program, the therapists at the MAIR clinic needs to understand what an
occupation is and how they can be instrumental tools in aiding how a child learns and
participates in daily occupations. This session will include readings about occupation as well as a
PowerPoint presentation that introduces specific occupations and terminology like activities of
daily living (ADLs), instrumental activities of daily living (IADLs), play, leisure, and social
participation. The therapists will be provided with a handout that lists these occupations as well
as descriptions that can be used as a reference in the future. Once the therapists have a better
understanding of what an occupation is, they will be introduced to the COPM outcome measure.
This is a valuable tool that they can use during the evaluation process that will help them identify
occupation-based interventions and goals that can be targeted in therapy. This session will also
give therapists the chance to practice their interviewing skills on each other in order to gain a
better understanding of the structure and flow of the COPM. Finally, the therapists will be able to
complete a COPM interview with a family currently on the MAIR clinic waiting list during the
hands-on portion of the day. This will give them an opportunity to begin using this tool in their
daily practice while having the occupational therapist close by to answer any questions and aide
in identifying occupation-based goals and interventions for each potential client.
The second day will primarily focus on educating the therapists about motivation and
volition. These are important concepts to understand when trying to implement new therapy
strategies, especially when working with children. Education will include discussion about what
techniques they are currently using to motivate children to participate in therapy as well as
introducing new strategies that can easily be included in their daily therapy. Another important
aspect of this session will be focused on teaching the therapists how to utilize the toys and
supplies they already have. The MAIR clinic is fortunate to have access to some art supplies,
toys and clothing that can be used in therapy. Though they have access to these items, they are
often underutilized and remain unused on the shelves of the clinic. Providing some instruction to
the therapists about various ways they can use these available items, as well as the items the
occupational therapists brought, will help them be more creative with their interventions and
therefore increase a child’s motivation and desire to participate in therapy. Again, the remaining
three hours of the day will be set aside for hands-on experience with clients to allow the
therapists to continue to implement this information into their daily practice with guidance and
assistance from the occupational therapist.
The third day will focus on providing the therapists with education about ways the
environment can be adapted and modified to increase a child’s occupational participation and
performance. This will be structured in the form of a presentation given by the occupational
therapist about commonly used modifications for this population followed by group discussions
and case-studies that will allow the therapists to select factors in the environment that can be
modified. Though the educational portion of this day is important, the hands-on experience with
actual clients will be the best learning tool for the therapists to fully understand this concept. As
the therapists work with their clients, the occupational therapist can ask questions and provide
feedback about how the environment is impacting the child’s ability to participate and perform
the task at hand. This is a skill that takes time to develop and will continue to be worked on
throughout the remaining days of training.
The fourth day will focus on introducing the idea of activity analysis to the therapists.
While this is an overall complex topic to include in this training, introducing principles of
activity analysis is important to ensure that the therapists are able to evaluate and modify the
activities and occupations they ask their clients to do. An important concept within activity
analysis to discuss with the therapists is the idea of developing and grading an activity. Providing
a thorough understanding of how to an activity is performed will allow the therapists to begin to
identify ways the activity can be graded, adapted, modified or created for optimal occupational
engagement from the client. A handout will be given to the therapists that discusses ways that
occupations and activities can be graded (i.e. changing the position of the client,
adding/subtracting steps or substituting the objects or tools needed to complete the task) as well
as ways they can be adapted (i.e. modifying a tool or fabricating equipment to increase ability to
client to participate). Learning how activities and occupations can be adapted and graded up and
down is a foundational skill that will allow the therapists to better implement occupation-based
interventions without having the comprehensive knowledge base that an occupational therapist
has. Finally, these principles will be implemented into practice in the remaining hours of the day
to ensure the therapists are understanding how to make these necessary changes in the moment
when working with clients.
The final day will be focused on providing a comprehensive wrap-up for the week-long
training. The therapists will be able to ask the OTR/L any remaining questions they have before
taking a final assessment. This assessment will be in the form of a case study that will test the
therapist’s knowledge, understanding and ability to implement the information they have learned
throughout the training. This will give the OTR/L an opportunity to fine-tune specific topics with
each therapists prior to leaving. Once this has been done, the remaining portion of the day will be
spent working directly with clients implementing occupation-based interventions. At this point,
the MAIR clinic therapists will be able to identify motivating occupations for the client, modify
the environment and adapt the activity to promote greater success and occupational engagement.
The OTR/L will observe the therapists and provide feedback when necessary. The remaining
time in the day will be used to give the therapists surveys that will assess their knowledge and
the program’s overall effectiveness.
Program considerations. In establishing an occupation-based intervention program like
the FITT, there are several factors to take into consideration to ensure the program is successful
and effective. This program was designed for the therapists at the MAIR clinic, therefore they
will be the only individuals that are eligible to attend this program. Additionally, this program is
focused on providing education for the therapists to implement occupation-based interventions
for children with cerebral palsy, but the knowledge learned in this training could be generalized
to all clients being seen at the MAIR clinic. Once the therapists have a foundational knowledge
of how to implement these kinds of interventions in their everyday practice with this specific
population, they should be able to apply what they’ve learned to other populations they work
with.
Program start-up. This program will require therapists at the MAIR clinic to attend a
week-long training provided by an occupational therapist which will introduce the program and
allow the therapists to have hands-on opportunities to problem-solve and learn with their clients.
The MAIR clinic currently has three full-time therapists on staff that would receive this training.
Ideally, as the program progresses and the therapist’s knowledge increases, this training could be
offered to other physical therapists working in Marrakech to allow occupation-based
interventions to become a more standardized part of rehabilitation and therapy in Morocco.
Unfortunately, due to the corruption and the limited number of therapists working within the
healthcare system, this training would be unlikely to occur outside the MAIR clinic. For now,
providing this training and education to the MAIR clinic staff would be sufficient to address the
current needs and gap in services identified for this population.

Space requirements. As the MAIR clinic already has an established space available, this
will be the location of the program training to ensure ease of access and attendance by the
therapists. By using this space, this will reduce costs that would be incurred if additional space
was needed for this program training. The 2,700 square foot clinic has ample tables and chairs
that can be used during the education portion of this program as well as computers and a
projection system to allow the occupational therapist to present the learning material in an
efficient way. For the hands-on learning opportunities, the clinic space will also be used to
educate the therapists about environmental and activity modifications that can be made to
increase occupational performance and participation for each client. Finally, a small filing
cabinet or shelf will be added to the clinic space for the therapists to store the educational
materials provided to them throughout this training.
Time requirements. The proposed program will take approximately one week to provide
the therapists at the MAIR clinic with proper training and hands-on opportunities to begin
implementing occupation-based interventions with children with cerebral palsy. This would
require the therapists to suspend treatment of their patients for one week in order to attend this
training. Though the majority of their patients will need to be cancelled, each therapist will be
asked to identify specific clients they would like to bring in and work with while the
occupational therapist is there. This will give the MAIR clinic therapists the opportunity to
implement interventions, ask questions and receive direct in-the-moment feedback from the
occupational therapist. This will be a valuable and necessary part of the program training.
Program marketing. Since this program is specifically designed to educate the
therapists at the MAIR clinic, marketing outside the clinic will not be necessary. Additionally, a
desire for this type of training was identified in the needs analysis, therefore minimal marketing
will need to be done to encourage the MAIR clinic therapists to attend this training. This
informal marketing will occur within the clinic environment through word of mouth and verbal
encouragement to attend the training. In the future, however, it could be beneficial to provide
marketing aimed at public hospitals, local orphanages and other therapists working in the area to
bring greater awareness to the services the MAIR clinic can provide for children with cerebral
palsy.
Budget. The overall budget for the FITT training program will be minimal, as many of
the necessary supplies and costs have already been contributed by in-kind donations to the clinic.
The therapists at the clinic already have access to computers that can be utilized during the
training as well as supplies that can be used as a part of the education of occupation-based
interventions (ex: art supplies, children’s clothing, toys, leisure supplies, etc.). The bulk of the
program’s cost will be incurred through travel expenses and money budgeted towards payment
for the occupational therapist’s preparation and presentation of the program. The budget will
allocate 10 hours of preparation time for the therapist with the remaining 30 hours attributed to
direct education and training. Additionally, the clinic will need to purchase some items that will
be used to enhance their ability to implement occupation-based interventions (i.e. COPM forms,
self-care items, etc.).
Though this program will only take one week, the therapists will be unable to see the
majority of their patients during this time, as training will happen during the day at the clinic
with only a select group of clients being brought in for hands-on experiences. This will affect the
income brought into the clinic for that week, but since many of the patients seen at the MAIR
clinic do not pay for the therapy they receive, this impact should be minimal. A more detailed
budget for this program can be found in Appendix F.

Funding options. The MAIR clinic is considered a non-profit organization and is
currently funded by grants and donations from the Salt Lake Rotary Foundation, which provides
all the funding necessary for training the clinic’s staff. The Salt Lake Rotary Foundation, a
subset of the Rotary Foundation, supports education and other community-based programming.
It is likely that this foundation would provide the funding necessary for this program because of
the relationship that has already been established (Rotary Foundation, 2018). In the case that the
rotary club could not fund this program, additional grants and outside funding would need to be
acquired. Using The Funding Opportunities website within the Spencer S. Eccles Health Library,
additional grants were located that could be used to fund this program. Search terms that were
used to narrow down the grant list included: health, Africa, rural areas, children and youth and
occupational therapy. This search resulted in choosing grants supplied by two other foundations,
The Sorrenson Legacy Foundation and The Firelight Foundation. The Sorrenson Legacy
Foundation provides financial support for a wide range of endeavors including education to
healthcare professionals as well as supporting the enhancement of quality of life for children and
families. Historically the Sorrenson Legacy Foundation has commonly provided grants
approximating $10,000, which would be more than adequate to fund this particular program
(Application Guidelines for Grant Seekers, 2009). The Sorrenson foundation is interested in
providing funding that supports children and youth, economically disadvantaged and low-income
people. This foundation would be an excellent source of funding for this program and is an ideal
match for the community the MAIR clinic resides in.
Additional grants were again located using the Funding Opportunities website within the
Spencer S. Eccles Health Library. The advanced search was used again with the following terms:
health, Africa, rural areas, children and youth. This search located The Firelight Foundation,
which focuses on identifying, funding and strengthening communities in Africa that support the
health and resilience of children. This organization seeks to fund programs that promote strong
community roots and empowerment as well as programs that aim to establish a culture of
learning. Typical grants from this foundation are $9,000, again enough money to cover the entire
cost of this program if necessary (Firelight, 2013). This foundation is interested in providing
funding that supports children and youth, economically disadvantaged people and academic
endeavors across the world. Again, this would be an ideal funding match for this program, as it
aims to educate therapists on providing interventions for children and youth in Africa.
Expected outcomes. The expected outcomes for this program are that therapists at the
MAIR clinic are able to increase their understanding and ability to implement occupation-based
treatments for their clients with cerebral palsy. In providing this training, the therapists will be
able to provide more comprehensive therapy for their clients with cerebral palsy while also
preventing occupational decline and increasing performance and participation in daily
occupations for this population. This training program’s main goal is to increase the therapist’s
understanding and competency to be able to integrate these types of interventions into their daily
practice. By offering occupation-based, client-centered interventions to children with cerebral
palsy, the therapist can help teach the child to be more successful when participating in daily and
desired occupations.
Program evaluation. In order to continue to refine and modify this program to meet the
needs of the MAIR clinic, ongoing evaluation will be instituted to ensure the program is effective
and efficient. The therapists will be asked to anonymously participate in a survey process that
evaluates the effectiveness of the program training. These surveys will consist of both
quantitative and qualitative data that can be used to track the therapists level of knowledge,
understanding and comfort with the information presented throughout the program. Quantitative
data will consist of a post-survey that includes the following questions that will be used to
compile numerical values that can be tracked long-term: 1). I understand the overall purpose of
this program, 2). I feel comfortable implementing this program with clients at the clinic, 3). I
have increased my knowledge in implementing occupation-based interventions with children
with cerebral palsy, 4). I am satisfied with the information and education I receive in this
program training, and 5). I have seen patient implement in occupation-based activities after
implementing this program. A sample of this survey can be seen in Appendix H.
To gain a better understanding of the therapist’s perception of the program, another
survey will be administered after training is complete. Again, this survey will be anonymous and
will include open-ended questions to allow the therapists to provide broad and comprehensive
feedback. The following questions will be included in that survey: 1). How has learning this
program changed the way you implement therapy for children with cerebral palsy? 2). What
part(s) of the program were the most helpful and why? 3). How/what improvements have you
seen in your patients since implementing this program? 4). What parts of this training program
could be better explained in order for you to more successfully implement occupation-based
interventions at the MAIR clinic? And 5). What did you know about occupation-based
interventions prior to attending this training? By asking these questions, the occupational
therapist will be able to fine-tune the content presented in the program for any additional
trainings provided in the future. This will also help the occupational therapist to assess the level
of understanding and education gained by the therapists at the end of this program training.
Again, a sample of this survey can be found in Appendix G.

Finally, to determine the therapist’s competence with the material presented in the
program training, a final assessment will be given to them at the end of the week. This
assessment will be in the form of a case study that will present the therapists with a hypothetical
situation for them to problem-solve. This assessment will cover all the material that was
presented throughout the program and will help the occupational therapist providing the training
with a better understanding of the MAIR clinic therapist’s understanding and knowledge in
implementing occupation-based interventions. This will also allow the occupational therapist to
identify any gaps in material that may have been missed and provide additional information and
reference materials to the MAIR clinic staff prior to leaving. An example of the final case study
can be found in Appendix E.
Overall, this program will assist the MAIR clinic therapists in gaining a better
understanding of ways to implement occupation-based interventions with their patients with
cerebral palsy. This program is greatly needed and would aid in the development and
participation of this population. By providing the therapists with this training program, they will
be able to provide greater comprehensive treatment to their patient and begin to implement
therapeutic interventions that increase the child’s occupational engagement, participation, and
performance.
References
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(2013). Rehabilitation service utilization in children and youth with cerebral palsy. Child:
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(2012). Amount and focus of physical therapy and occupational therapy for young
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Appendix A
Therapist Interview Questions
 What is the purpose of your organization? (Mission statement, philosophy, etc.)

 What group of individuals do you serve?
 What are some of the characteristics of this group? Diagnoses, LOS, what other services
do they usually get?
 What are your funding sources?
 What kinds of programming/services do you currently offer?
 What plans for different or additional services, etc. in the future?
 Based upon your knowledge of your clients (e.g., participants, members, patients, etc.)
and how they function in your program or after they leave, what gaps do you see in their
functioning or skill levels?
 What percentage of your patients are pediatric vs. adults?
o What diagnoses do you see most frequently?
 What areas/diagnoses do you wish you had more experience/education about?
o Are you provided with any additional trainings/courses on these areas?
o Does the clinic provide the funds for you to access additional trainings or do you
have to pay for them on your own?
 Where do your patients come from?
o Are they local or coming from different cities/countries?
 What training/licensure/certification does your staff have?
o How many therapists work in the clinic?
 What types of treatment and intervention are therapists currently doing?
o How long are typical treatment sessions?
o Frequency?
o Does the clinic have productivity standards that they are trying to reach on a day-
to-day basis?
 What types of specific evaluations and assessments are being performed currently in the
clinic, if any?
 What types of programs have been proposed or implemented in the past?
o Were they helpful?
o What made them successful/unsuccessful/difficult to implement?
 What are some of the clinic’s biggest needs right now?
 What resources (textbooks, websites, programs, protocols, etc.) does the clinic have
available to them and which ones are utilized the most?
 What areas of everyday functioning are currently addressed or not addressed in the ways
you believe are optimal?
 Do you have parent support groups or other groups that you run?
o Do you ever provide group therapy for the kids?
 What are the clinic’s long term goals?
 What is your contract like with the clinic?
o Do you feel like your caseload is too large?
o Are you able to leave the clinic if you chose to?
 What are the clinic’s biggest strengths?
 What are the clinic’s biggest weaknesses or areas of growth?

 What are your own personal strengths and weaknesses?
 How active are families in the therapy process?
o How do you get parents involved?
o Do you frequently do home evaluations?
o Is there a contract that parents sign prior to starting therapy?
 Do you feel like you have enough time to complete documentation throughout the day?
o How long does it take you to complete a note?
o What information are you putting into a daily note?
o What information is lacking from your notes or do you wish you had more time to
discuss?
 What information did we provide you that was beneficial?
o What information did we provide you that was not beneficial?
o What information did we not provide you that you wanted more of?
 What could a group do different next time to make this a more beneficial and successful
experience for you?
Appendix B
Parent Interview Questions
 What are some of your favorite things about the clinic?

 Do you enjoy being a part of your child’s therapy at the clinic?
 What concerns do you have about your child at home?
 What are your current goals for your child?
o What activities would you like them to be able to participate in?
 What occupations or activities do you wish your child could do more independently?
 Do you feel like you understand your child’s home exercise program and know what you
should be doing at home?
 Are you feeling any burnout or excessive strain from taking care of your child?
o Are there any resources for you to contact if you feel excessive burden?
 How are you being supported at/by the clinic?
 Is there anything about your child’s therapy that you would like to change or add?
 What would you like more of at the clinic?
 How did you hear about the MAIR clinic?
 Would you be willing to do more occupation-based activities with your child at the
clinic?
 What toys/activities/resources do you have available in your home for your child to play
with, if any?
 What does your child enjoy doing during the day?
Appendix C
Child Interview Questions
 What are some of your favorite things to do during the day?

 What activities do you enjoy doing at home? School?
 What things are hard to do during the day?
 What do you want to be able to do but can’t do right now?
 What makes you really happy?
 What is your favorite part of therapy/coming to the MAIR clinic?
 What is your least favorite part of therapy?
 What do you feel you are good at?
Appendix D
Clinic Director Interview Questions
 What is the length of stay for the MAIR clinic?

o Typical length of each session?
 How many patients are seen a day, and what percentage are adults vs. children?
 What current programs are you implementing at MAIR (ex: feeding, gait training, ROM,
etc.)
o What programs would you like to implement in the future?
 What does funding look like for the clinic?
o How does the Rotary Club play a role in funding?
 How many therapists are on staff?
o How many interpreters?
o Any other staff members and what role do they play?
 What is the education of the therapists?
 How do you prioritize patient care/your waiting list?
 How far are people traveling to get to the clinic?
o What types of transportation is needed?
o Is public transportation accessible for individuals with special needs?
 How do people pay for services?
o How do you charge for different services (if applicable)?
o Do you use a pay scale?
 How do you envision occupational therapy being incorporated into the clinic?
o What do you hope to achieve by incorporating OT services?
 What are your future plans for the clinic?
 Ultimately, what do you need or would you like us to contribute?
 How are people referred to, or find out about the clinic?
 What type of scheduling system do you use?
 What is the process for evaluating patients and planning their care?
o How do the therapists determine exactly what they are going to do with a patient?
 How do the therapists currently document?
o Will we have access to charts to show what they are doing for their plan of care?
 If a plan of care is not currently being established, is that something you could benefit
from?
 Is telehealth still happening through the clinic?
o Is it working for your patients?
o How could it be improved?
 What is your plan to make the clinic sustainable?
 What is currently working for the clinic, and what needs improvement?
 What are strengths of the clinic?
 What are areas of growth for the clinic?
 Who have your partnered with, both locally in Morocco and here in the United States, to
increase funding or resources for the clinic?
Appendix E
Curriculum Example
This is an example of a final assessment I would give to the therapists to independently work on
as a part of my program evaluation. This is a case study that will allow the therapists to use the
knowledge and skills they have gained throughout the training and apply it to a specific case.
This will be used as a competency and can help the occupational therapist performing the
training test the therapist’s understanding and ability to implement the program with a client.
Case study: You receive a referral for a 7 year old girl with a diagnosis of cerebral palsy. When
she is brought to your clinic for an evaluation, her mother describes her as happy and energetic.
She enjoys helping her mom make tea, going to school and playing games with her siblings. Her
mom explains that because of the high tone in her legs, getting dressed in the morning and at
night is difficult. Additionally, she has a hard time completing self-care tasks like brushing her
hair and teeth and has difficulty playing with small toys and puzzles due to poor fine motor
skills. The client would like to be able to get ready in the morning without help from her mom
and play more with her friends during the day.
Answer the following questions with as much detail as possible.
1. Identify at least 3 occupations that can be addressed in therapy with this client. How did you
identify those occupations and why did you choose those specific occupations?
2. Pick one of the occupations listed above and explain how you will incorporate it into your
traditional therapy that you provide.
3. What barriers or factors in the environment could be adapted/modified to increase the child’s
participation and performance in this occupation?
4. How could you grade this activity down (or how would you make this activity less
challenging)?
5. How could you grade this activity up (or how would you make this activity harder)?
6. Write one occupation-based goal that could be added to this child’s plan of care.
Appendix F
Line-Item Budget Detail for the FITT Program
Source of Specific costs or sources of Cost

income
Start-up Costs
OT salary for training Based on average salary of OT in Utah $1,543
$80,260/52= $1,543
$1,543 for one week of training
Tables and chairs In-kind contribution $0
(2 tables x $100) and (5 chairs x $25)
(Costco)
Total cost= $325
Computers/equipment In-kind contribution $0
HP 14” laptop (Costco) $399 x 3 for
each therapist
Total cost= $1,197
Total= $3,065
Direct Costs
Supplies for training  In-kind contributions
and treatment Art supplies (paper, pencils/markers, $0
scissors, paint, coloring books, etc.)
(Walmart)
Total cost = $100
Clothing for dressing (children’s sized
shirts, pants, socks and shoes)
(Walmart)
Total cost = $100
Leisure activity supplies (balls, books,
etc.) (Walmart)
Total cost = $50
 Items needed to purchase

Self-care/grooming items (toothbrush, $30
hairbrush, etc.) (Walmart)
Computer based COPM assessments (E- $39.34
book and 100 forms)(CAOT website)
Miscellaneous items $50
MAIR staff salary to In-kind contribution $0

attend 2 weeks of $800/month (salary of therapists)
training $800/4 = $200
$200 for one week x 3 therapists = $600
Travel expenses 1 week of hotel expenses at Hotel $400.05
LePrintemps
$57.15 per night x 7 nights = $400.05
Roundtrip airfare from Salt Lake City to $1,100

Marrakesh x 1
Miscellaneous travel expenses (food,
transportation) $210
$20/day for food x 7 days=$140
$10/day for transportation= $70
Total= $2,279.39
Indirect Costs
Rent In-kind contribution $0
2,700 sq. ft. x $13= $35,100
$35,100 x 52 = $675
$675 x 2= $1,350
Utilities In-kind contribution $0
Gas, water, telephone, internet
$100
Maintenance In-kind contribution $0
10% of rent
$135
Total= $1,585
Income
Total= $0
Budget Summary
Total costs $7,329.39
Total income or in- In-kind contributions supplied by grants

kind contributions and funding donated to the clinic
Net cost of program $3,372.39 to be covered by

grants/funding/donations to the clinic
Notes: total for in-kind contribution: $3,957

Appendix G
Program Evaluation Tools
Qualitative Data Collection

Therapist interview regarding program training
1. How has learning this program changed the way you implement therapy for children with
cerebral palsy?
2. What part(s) of the program were most helpful and why?
3. How/what improvements have you seen in your patients since implementing this
program?
4. What parts of this training program could be better explained in order for you to more
successfully implement occupation-based interventions at the MAIR clinic?
5. What did you know about occupation-based interventions prior to attending this training?
Appendix H
Quantitative Data Collection
Likert Scale Questionnaire for Therapists
Rate your understanding and level of satisfaction regarding the FITT training program using the
following scale:
1= Strongly Disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
o I understand the overall purpose of this program training.
1 2 3 4 5
o I feel comfortable implementing this program with clients at the clinic.
1 2 3 4 5
o I have increased my knowledge in implementing occupation-based interventions with

children with cerebral palsy.
1 2 3 4 5
o I am satisfied with the information and education I received in this program training.
1 2 3 4 5
o I have seen patient improvement in occupation-based activities after implementing this

program.
1 2 3 4 5

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FUNCTIONAL INTERVENTION TRAINING AND THERAPY 1

The FITT: Functional Intervention Training and Therapy:

An Occupational Therapy-Based Community Program for the MAIR Clinic

The FITT: Functional Intervention Training and Therapy:

An Occupational Therapy-Based Community Program for the MAIR Clinic

The purpose of this assignment is to incorporate the skills and knowledge of an

occupational therapist into a program of an underserved and rural population in Marrakech,

MAIR clinic is:

To trigger a neuroplastic change is the foundation of our therapy. To accomplish maximal

recovery is our most important goal (MAIR, 2018).

personal communication, September 26, 2018).

rehabilitation is the primary treatment intervention performed at MAIR, with an emphasis on

continue coming to therapy (M. Sbai, personal communication, September 9, 2018).

patient’s rehabilitation or remediation potential. Even more concerning, this maintenance

caregiver burden (M. Sbai, personal communication, October 8, 2018).

within the system.

appropriate (I. Bentahar, personal communication, October 7, 2018). Additionally, the

in order to ensure this clinic is successful and sustainable.

disasters including earthquakes, droughts, windstorms, flashfloods and landslides. Other

Additionally, Morocco is currently undergoing a shift from rural living to urbanization. In

Benhahar, personal communication, October 9, 2018).

Within the MAIR clinic’s culture, however, there is an overwhelming sense of

MAIR community but also within the overall culture as a whole.

Factbook: Morocco, 2018).

open, market-oriented economy. The main economic foundation of Morocco is supported by

force and being seen in virtually all professions (Laskaridis, 2011).

(M. Sbai, personal communication, October 6, 2018).

Political. Morocco is considered a constitutional monarchy and is one of the oldest

can receive care (Morocco Health Insurance, 2018).

never really discharged from the MAIR clinic.

patients (M. Sbai, personal communication, October 9, 2018).

their therapy (M. Sbai, personal communication, September 9, 2018).

Programming Strengths and Areas for Growth

Director and Therapy Staff Perspective

organizing therapist’s documentation or accessing patient medical records. This disorganization

are addressed (M. Sbai, personal communication, September 10, 2018).

Therapists. To gain a greater understanding of the therapist’s perspective, a group

Elghazi, S. Berrada, personal communication, October 10, 2018).

Parent and client perspective. In order to improve our understanding, one-on-one

group, personal communication, October 12, 2018).

Student perspective. After completing observations, interviews and trainings with

stretching, strengthening or walking with their children, performing in a co-treating fashion

that the clinic takes seriously and does very well.

dynamics or environment like a typical occupational therapy evaluation would. Additionally,

physical-therapy focused, it would be valuable to introduce and integrate occupational therapy

established by the families, therapists and Sbai.

Evidence-Based Practice Literature Review

An evidenced-based literature review was completed to gain a better understanding of the

occupational needs of children receiving rehabilitation services in Marrakech, Morocco as well

occupation-based interventions, functional-based interventions, international healthcare,

activities of daily living (ADLs), self-care, rehabilitation/treatment/intervention, programs,

Commonly seen patient characteristics and diagnoses

Morocco, literature was reviewed to gain a greater evidence-based perspective on commonly

is the focus of this occupation-based program proposal and literature review.

can be tremendous impacts on the children and their overall health.

to be addressed in order to improve health for all.

Viewing occupation from a worldwide lens

In order to gain a better understanding of the role of therapy and rehabilitation in

easy to understand. However, as occupational therapists, we have a unique perspective that

communication, October 7, 2018).

Therapy and rehabilitation in Morocco

one-discipline approach for therapy to a multi-disciplinary approach enables children with CP to

Role of occupational therapy in cerebral palsy rehabilitation